By Christine Taxin
Are you an office that provides treatment and services like implants, oral appliance therapy, TMD assessments, oral surgery or periodontal care? If so, you may be missing out on an enormous opportunity: medical billing. There are many dental procedures that are considered medically necessary and can therefore be billed to a patient’s medical insurance successfully. With some basic knowledge and assistance from Links2Success, your office can tap into a previously untouched revenue stream while also providing better care to your patients.
Medical coding de-coded
Most practices we advise are intimidated by the seemingly limitless coding options. Now, with the launching of ICD-10 many are even more nervous about venturing into medical coding. However, many dental plans are requiring knowledge and use of ICD-10 in order to request additional wellness benefits for high risk patients. In addition, Links2Success has been working feverishly to develop specialized user manuals for dental offices to help narrow down the coding options and provide guidance for those new to the process. The bottom line is billing medical insurance requires the team to listen to the patient’s story and then tell that story to the insurance company clearly. When an office can do that well they see higher case acceptance, increased practice revenue and happier, healthier patients.
Medical billing with confidence
Medical billing requires diagnosis-based documentation. Follow these simple steps and you will be on your way to successfully billing medical insurance:
- Ask for a list of current medications as well as the Rx provider
- Conduct risk assessment for dental caries, perio and medical history
- Be acutely aware of the patient’s family medical/dental history
- Always document onset of symptoms, i.e. when did the patient first notice bad breath, jaw pain, apnea episodes or any other symptoms or complaints.
Emulating the medical model in your record keeping will be an important first step in confident coding. Among the standardized forms and procedures that you will need to file successful claims are:
- Medical claim form CMS 1500
- Verification of Benefits
- ICD-10 diagnostic codes showing the condition, disease, or symptoms
- CPT procedure codes to specify your services
- Written SOAP reports (Subjective complaints, Objective exam findings, Assessment, and Plan). SOAP reports should include medical history, review of systems, social history, history of present illness, exam notes and the plan for treatment.
SOAP reports and letters should be sent to medical insurance for appropriate reimbursement and, with your patient’s signed permission, they should also be sent to their treating physician. The report informs the physician about your treatment plan in order to ensure coordinated care. If done consistently you may also reap the benefits of physician referrals to your office. Few dentists submit such important health information to their patient’s medical doctors.
Take the first step
If providing the best care to patients is your primary goal, medical billing should be a regular part of your offerings. When an office can tell a patient their treatment will be covered by insurance, and medical insurance at that, patients feel like you are going above and beyond. They will refer you to friends and family and be more likely to follow through with suggested treatment and your patients’ oral health goals will be more likely achieved.
Christine Taxin’s workshop and lecture attendees benefit from her expertise in advanced dental billing, dental to medical cross-coding, administrative and wellness systems. Her company, Links2Success, is approved as a PACE continuing education provider through the Academy of General Dentistry.